Gluten-Free: Diet Trend or Medical Necessity?
By Julie Holland Faylor, MHS, CEDS
Open a magazine, visit a restaurant or shop for groceries and you’re likely to observe the gluten-free diet craze. Books, magazines and blogs claim various health and weight loss benefits from eliminating gluten from our diets, restaurants tout separate gluten-free menus, and grocery stores have added whole aisles dedicated to gluten-free foods. In fact, the gluten-free eating trend has become so pervasive that there’s even a gluten-free Girl Scout cookie!
For many people, gluten-free eating is the latest fad. However, for people like me with celiac disease, it’s a necessity. According to the National Foundation for Celiac Awareness, only 1 in 133 Americans have celiac disease, a genetic autoimmune illness that damages the small intestine and restricts the body’s ability to absorb nutrients from food. People who have this disease cannot tolerate gluten, a protein found in wheat, rye and barley. If any gluten is ingested, even a small amount, uncomfortable medical symptoms develop shortly afterwards, including abdominal pain, diarrhea, vomiting and constipation. In addition to those with celiac disease, there is a portion of the population who have non-celiac gluten sensitivity. These people also cannot tolerate gluten, and while they may experience similar symptoms, they don’t experience the same damage to their small intestine.
As an eating disorder specialist, two things are concerning to me about the swift rise in gluten-free diets—the connection between dietary restriction and eating disorders, and the impact of the growing popularity of elective gluten-free eating on people without medically-verified gluten intolerance or celiac disease.
Eating disorders often begin with a seemingly innocent diet—medically indicated or otherwise—and many diets call for the elimination of entire food groups like gluten, dairy or meat. Sometimes, dietary restriction can lead to disordered eating behaviors like “orthorexia,” a condition characterized by an unhealthy preoccupation with healthy eating. In other cases, dietary restriction can lead to a full-syndrome eating disorder (the dieting behavior activates the latent genetic predisposition toward developing an eating disorder—remember, eating disorders are hereditary! Link to first post) For individuals without a medically diagnosed gluten intolerance that elect to stop eating gluten, I encourage them to think about why they are making this significant change to their diet. In general, whole grains are an important part of a balanced pattern of eating, and labeling foods as “good” and “bad” can stigmatize eating and reinforce the cycle of dieting and dietary restriction. A simple best practice following any significant change in food intake is to consult with a registered dietitian to establish an optimal nutrition plan. While doing so, it is important to specify that the gluten-free change is a dietary preference rather than a medical necessity. Regardless of our diet choices or mandates, it is important to keep wellness and balance in mind.
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Additionally, the gluten-free diet fad creates a misperception that gluten-free is merely a preference, not a medical necessity. As a result, gluten-free standards have relaxed to the point where many products and menus claiming to be free of gluten actually contain some measure of wheat, rye or barley. This makes it more challenging to practice a medically-indicated gluten-free diet. While food products must list their ingredients, gluten-free menus at restaurants can be blatant offenders, not taking the time to truly understand what gluten is and in what products it is used. In my personal experience at many restaurants, I have ordered meals from these special menus that actually contained gluten ingredients like soy sauce, and I felt terribly sick shortly after. In a sense, it seems as though elective gluten-free eating has trivialized a celiac disease diagnosis. I encourage those with gluten intolerance to be hyper-vigilant about their product choices and restaurant visits—in light of the gluten-free trend, we have to listen to our bodies even if a label or menu item claims to be gluten-free.
In today’s culture, dieting is pervasive. Gluten-free eating is all the rage this year, the latest in a long line of fads and gimmicks like low/no-carb, high protein, raw, fat-free, sugar-free—the list goes on and on. While the majority of diets are elective in nature, some diets—including the dietary restrictions of individuals with celiac disease—are medically indicated. Regardless of the motivation for the diet or the diet’s underlying philosophy, it is important to understand the connection between dieting and eating disorders. In fact, research has found that 35 percent of “normal dieters” progress to pathological dieting, and of those, 20-25 percent progress to partial or full-syndrome eating disorders.* With this statistic in mind, caution must be exercised when any sort of dietary restriction is taking place.
* Shisslak, C.M., Crago, M., & Estes, L.S. (1995). The Spectrum of Eating Disturbances. International Journal of Eating Disorders, 18 (3): 209-219.